I. To compare the difference in the biochemical progression-free survival rate (bPFS) at 2-years between immediate ADT for nine months in high risk prostate cancer patients following radical prostatectomy and a similar high risk patient population followed without initiation of immediate ADT treatment.
I. To determine the three year difference in bPFS, prostate cancer specific survival, and overall survival between immediate ADT for nine months and observation for high risk prostate cancer patients following radical prostatectomy. II. To evaluate the toxicity profile and quality of life (QOL) measured by FACT-P and linear analogue self assessment (LASA) between two treatment arms.
I. To explore if serum and urine biomarker(s) levels at study entry, 9 months, or 24 months in the two treatment arms are correlated with biochemical progression-free survival rate.
II. To explore if > 5 circulating tumor cells (CTCs) or circulating endothelial cells (CECs) following study treatments are associated with biochemical progression-free survival rate.
III. To explore the prognostic and predictive value of tissue based biomarkers in high risk prostate cancer patients.
This is a randomized phase II study.
Patients are stratified according to pathological Gleason score (6-7 vs >=8) and baseline PSA at diagnosis (<10 ng/mL vs >=10 ng/mL). Patients are randomized to 1 of 2 arms.
Arm A: Patients receive leuprolide acetate intramuscularly on day 1 OR goserelin acetate subcutaneously on day 1. Treatment repeats every 3 months for a up to 3 courses in the absence of disease progression or unacceptable toxicity.
Arm B: Patients undergo observation every 3 months for 9 months. After completion of study treatment, patients are followed every three months for 2 years. PROJECTED ACCRUAL: A total of 128 patients will be accrued for this study.
Prostate cancer patients with high-risk features may be screened for participation either prior to (pre-registration) or after (registration) radical prostatectomy
Pre-registration: Informed consent explained and signed prior to any study related procedures
Pre-registration: Patients with any one of the following "high risk" criteria: clinical or pathological Gleason score 8-10; PSA > 20 ng/mL at initial presentation prior to radical prostatectomy
Pre-registration: Willingness to provide mandatory tissue for research purposes
Pre-registration: Willingness to provide mandatory blood for research purposes
Registration: ECOG performance status of 0, 1, or 2; or Karnofsky performance of > 60%
Registration: Patients with any one of the following "high risk" criteria: GPSM score >= 10 [GS + 1*(PSA 4-10)+2*(PSA 10.1-20)+3*(PSA>20)+2*(Seminal Vesicular or nodal involvement) +2*(margin)] (determined post radical prostatectomy)
Registration: Patients with any one of the following "high risk" criteria (continued from previous criterion): post prostatectomy seminal vesicle invasion (pT3b) or pT4; two or less microscopic lymph nodal metastasis determined at the time of prostatectomy; or Gleason 4+3 at the time of prostatectomy with margin positivity
Registration: Please contact study investigator and/or consult protocol document for specific details on laboratory criteria
High risk patients will do one of the following:
1. for patients identified as high-risk on the basis of pathological criteria after undergoing radical prostatectomy: interval time for study enrollment after radical prostatectomy will be <= 28 days of the prostatectomy;
2. for patients identified as high-risk prior to undergoing radical prostatectomy: patients presenting with a high Gleason score (8-10) and/or a PSA >20 ng/ml are deemed eligible for study participation and study registration as long as the eligibility criteria is re-confirmed post radical prostatectomy
Registration: These patient groups may choose to register prior to or after prostatectomy
Registration: Study randomization must occur =< 28 days of radical prostatectomy
Registration: All patients consented on the trial, whether consented in the pre-prostatectomy or postprostatectomy period, will be randomized to study treatments =< 28 days of prostatectomy
Registration: Ability to complete questionnaire(s) by themselves or with assistance
Pre-registration: Transitional cell, small cell, or squamous cell carcinoma of the prostate
Pre-registration: Patients consented for participation prior to prostatectomy, if detected to have above listed histo-pathologies after prostatectomy will be deemed ineligible and not proceed to study randomization
Pre-registration: History of primary prostate cancer treatment
Pre-registration: Evidence of clinical nodal disease (N1) or grossly evident metastasis at the time of enrollment
Pre-registration: Androgen deprivation therapy within the past 6 months (these agents include LHRH agonists, anti-androgens, 5 alpha-reductase inhibitors, estrogens, ketoconazole, or corticosteroids or peripheral anti-androgens)
Pre-registration: History of bilateral orchiectomy
Pre-registration: Unilateral orchiectomy with normal range serum testosterone levels will be allowed for enrollment
Pre-registration: Evidence of metastasis on radiographic metastatic workup within a preceding period of 4 months from the time of study entry, including whole body radionuclide bone scan, CT and/or MR scan of the pelvis and abdomen; otherwise will perform at the time of the baseline tests and result must be normal to continue on study
Pre-registration: Results of ProstaScint or other radionuclide scans, excluding radionuclide bone scans, will NOT be used to establish metastatic disease if all other studies are negative
Pre-registration: Receiving other experimental drugs =< 4 weeks prior to consenting Pre-registration: Uncontrolled infection
Pre-registration: History of other cancer, excluding squamous cell and basal cell skin cancers, within the preceding 2 years
Pre-registration: Documented history of HIV positivity or other acquired immunodeficiency disorder, congenital immunodeficiency disorder, or history of organ transplantation
Pre-registration: Unable to follow up every three months for the first year to Mayo Clinic, Rochester for receiving LHRH analogues or study monitoring
Registration: Uncontrolled infection Registration: Unable to follow up every three months for the first year to Mayo Clinic, Rochester for receiving LHRH analogues or study monitoring
Last updated: 12/13/2012